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Case Report
Tuberculosis as a risk factor for brain and spinal injuries
1 Medical Sciences Course, Health Sciences School, Faculdade Ceres (FACERES), São José do Rio Preto, SP, Brazil
2 Neurosurgeon, Member of the Brazilian Society of Neurosurgery, Santa Mônica Hospital, Goiânia, GO, Brazil
3 Neurosurgeon, PhD in Neurosurgery, Member of the Brazilian Society of Neurosurgery, Professor at Santa Mônica Hospital, Goiânia, GO, Brazil
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Julia Brasileiro de Faria Cavalcante
Av. Anísio Haddad, 6751, Jardim Francisco Fernandes, São José do Rio Preto, SP,
Brazil
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Article ID: 101164Z01JC2020
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How to cite this article
Cavalcante JBF, Cavalcante RBF, Valente VF, Cavalcante JES, Cembraneli IN, Cembraneli PN. Tuberculosis as a risk factor for brain and spinal injuries. Int J Case Rep Images 2020;11:101164Z01JC2020.ABSTRACT
Introduction: Intracranial tuberculomas are granulomatous lesions that can occur in approximately 1% of the patients with active tuberculosis (TB). Although it is an uncommon disease, it usually causes severe neurological deficits, including altered mental status, hydrocephalus, cranial nerve palsy, hemiparesis, and seizures. Concomitant presentation of brain and spinal involvement is a rare entity and few cases have been described in the medical literature.
Case Report: We report a case of a 38-year-old female who presented with brain and spinal cord injuries due to TB without pulmonary changes. The patient first complained about intense holocranial headache and underwent cranial computed tomography with normal result. In a 6-year period, she had several different symptoms, underwent various types of laboratory and imaging exams, followed some drug therapies, and underwent some surgical procedures. After a diagnosis of intracranial granulomas compatible with TB, she followed a rifampicin + isoniazid + pyrazinamide + ethambutol (RIPE) scheme. However, after some months, she had seizures despite the use of anticonvulsant drugs, felt dizzy, experienced loss of balance, and had severe headaches again. After a diagnosis of ventricular dilation, she started taking acetazolamide in addition to the previous prescription, but soon after she needed ventriculoperitoneal shunt implantation.
Conclusion: The history of this patient raises the hypotheses of reactivation of TB due to inefficacy of medication or because of drug resistance. The diagnosis of TB should always be taken into consideration in nodular or pseudotumoral forms in the brain, even in immunocompetent patients without a history of this disease.
Keywords: Disseminated tuberculosis, Intracranial tuberculoma
SUPPORTING INFORMATION
Author Contributions
Julia Brasileiro de Faria Cavalcante - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Renata Brasileiro de Faria Cavalcante - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Volmer Fernandes Valente Junior - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
José Edison da Silva Cavalcante - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Italo Nogarotto Cembraneli - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Pedro Nogarotto Cembraneli - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2020 Julia Brasileiro de Faria Cavalcante et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
